Rural Health Clinics in Accountable Care Organizations: Impact on Disparities

拟议的纵向研究调查了农村卫生诊所（RHC）为老年人提供的护理 美国南部地区的成年人，以及医疗费用。责任医疗组织 （ACO）提供了潜在的机会，尽管一些农村限制ACO的参与。 然而，关于ACO模型如何适应RHC的独特挑战知之甚少， 参与RHC对农村老年人（包括少数群体）健康差异的影响。 本研究的具体目的是：（1）分析和描述RHC参与ACO的程度， 选择参与ACO的RHC的特征; 2）分析ACO的参与和其他 影响农村卫生服务机构服务人群健康差异的因素; 3）分析ACO 参与和其他影响RHC老年人成本效益和预防护理有效性的因素 成人患者。主要的研究假设是：1）更高比例的提供者为基础的RHC将 与独立的RHC相比，参与ACO; 2）网络中的RHC将更有可能参与 在ACO中，大型RHC比小型RHC更有可能参与ACO; 4） RHC参与ACO与减少农村老年患者的差异呈正相关， 控制情境因素的影响; 5）RHC参与ACO的质量与RHC参与ACO的质量呈正相关。 护理做法，控制背景因素的影响（如民族/种族分布和农村）; 6)RHC参与ACO与农村老年患者的健康结局呈正相关， 背景因素（如民族/种族分布和农村）的影响;以及7）RHC参与 将对成本效益和预防保健有效性产生积极影响。我们会三角定位 我们的分析采用定量和定性的研究方法，包括分析次级 数据、调查研究和案例研究。对七年组织和 将对大约800个RHC小组的社区相关数据进行分析，以开发更多 关于影响RHC绩效和结果的因素的可概括的想法。

The proposed longitudinal study investigates the care provided by Rural Health Clinics (RHCs) to older adults in the Southern region of the U.S., as well as the costs of that care. Accountable Care Organizations (ACOs) offer potential opportunities to RHCs despite several rural constraints to ACO participation. However, little is known about how the ACO model accommodates the unique challenges of RHCs, and the impact of RHC participation on the health disparities of rural older adults including those of minority groups. The specific aims of the study are: 1) to analyze and describe the extent of RHC participation in ACOs, and the characteristics of RHCs that choose to participate in ACOs; 2) to analyze ACO participation and other factors that impact health disparities of rural populations served by RHCs; and 3) to analyze ACO participation and other factors that impact cost efficiency and preventive care effectiveness for RHC older adult patients. The major research hypotheses are: 1) A higher percentage of provider-based RHCs will participate in ACOs compared to independent RHCs; 2) RHCs in networks will be more likely to participate in ACOs than unaffiliated RHCs; 3) Large RHCs are more likely to participate in ACOs than small RHCs; 4) RHC participation in ACOs is positively related to reduction of disparities of older adult rural patients, controlling for the effects of contextual factors; 5) RHC participation in ACOs is positively related to quality of care practices, controlling for the effects of contextual factors (such as ethnic/racial distribution and rurality); 6) RHC participation in ACOs is positively related to health outcomes of older adult rural patients, controlling for the effects of contextual factors (such as ethnic/racial distribution and rurality); and 7) RHC participation in ACOs will have a positive impact on cost efficiency and preventive care effectiveness. We will triangulate our analyses by using both quantitative and qualitative research methods including analysis of secondary data, survey research, and case studies. Multivariate analyses of seven years of organizational and community-related data of a panel of approximately 800 RHCs will be performed in order to develop more generalizable ideas about the factors contributing to RHC performance and outcomes.